Staging of oesophageal cancer (cancer of the gullet)

Staging systems are constantly being updated to help doctors plan the best treatment and help give an idea of the likely outcome. This means they are becoming increasingly detailed and complicated.

Your doctors may describe your cancer using either the TNM staging system or number staging.

TNM staging

This system gives precise information about the stage of the cancer.

T stands for tumour. It refers to the size of the tumour and whether it has begun to spread to nearby structures, such as the muscle or skin.

N stands for nodes. It refers to whether the cancer has spread to the lymph nodes.

M stands for metastasis. It refers to whether the cancer has spread to another part of the body such as the liver or lungs (known as a secondary or metastatic cancer).

Tumour size (T)

Doctors put a number next to the ‘T’ to describe the size and spread of the cancer.

T1

The cancer has grown into the inner layer (mucosa/sub-mucosa) of the oesophagus.

T2

The tumour has grown into the muscle layer (muscularis) of the oesophagus.

T3

The tumour has grown into the outer layer (adventitia) of the oesophagus.

T4

The tumour has spread to structures nearby. T4 is divided into two:

• T4a - The cancer has spread to the covering of the lungs (the pleura), the outer covering of the heart (the pericardium) or the muscle layer under the lungs (the diaphragm).
• T4b - The cancer has spread to other nearby structures, such as the windpipe (trachea), spine or major blood vessels (aorta).

Lymph nodes (N)

The ‘N’ may have a number written next to it, which gives extra information about the nodes that were examined.

N0 

There are no cancer cells in any lymph nodes.

N1

There are cancer cells in 1-2 lymph nodes.

N2

There are cancer cells in 3-6 lymph nodes.

N3

There are cancer cells in seven or more lymph nodes.

If cancer cells have spread to the lymph nodes, the nodes are said to be positive.

Metastasis (M)

The ‘M’ may have a number written next to it, which gives extra information about where the cancer has spread to.

M0 

The cancer cells have not spread elsewhere in the body.

M1 

The cancer cells have spread to other parts of the body. This is called secondary or metastatic oesophageal cancer.

Number staging

Stage 0

This is a very early stage of oesophageal cancer. It’s sometimes called carcinoma in situ (CIS) or high-grade dysplasia (HGD). There are severely abnormal cells present, but they’re contained entirely within the lining of the oesophagus. If left untreated, the cells could develop into an invasive cancer. There are usually no symptoms at this stage.

Stage 1A

The cancer is found only in the lining of the oesophagus (mucosa/submucosa). It has not spread to nearby tissues, lymph nodes or other organs (its TNM stage would be T1, N0, M0).

Stage 1B

The cancer has begun to spread into the muscle layer of the oesophageal wall (muscularis), but not to nearby lymph nodes or other organs (its TNM stage would be T2, N0, M0).

Stage 2A

The cancer has grown through the wall of the oesophagus (the adventitia), but not to nearby lymph nodes or other organs (its TNM stage would be T3, N0, M0).

Stage 2B

The cancer is in the top two layers of the oesophagus (mucosa and muscularis) and has spread to 1-2 lymph nodes. It has not spread to other organs (its TNM stage would be T1 or T2, N1, M0).

Stage 3A

The cancer has spread to the pleura, pericardium or the diaphragm, but not to any lymph nodes or anywhere else (its TNM stage would be T4a, N0, M0), OR it has grown into the outer layer (adventitia) of the oesophagus and into 1-2 lymph nodes, but no other organs (its TNM stage would be T3, N1, M0), OR the cancer is in the top two layers of the oesophagus (mucosa and muscularis) and has spread to 3-6 lymph nodes, and nowhere else (its TNM stage would be T1 or T2, N2, M0).

Stage 3B

The cancer has grown into the outer layer of the oesophagus (the adventitia) and to 3-6 lymph nodes. It has not spread to any other organs (its TNM stage would be T3, N2, M0).

Stage 3C

The cancer has spread to the pleura, pericardium or the diaphragm and up to six lymph nodes are affected (its TNM stage would be T4a, N1 or N2, M0), OR the cancer has spread to nearby structures, such as the windpipe or spine, and to any number of lymph nodes (its TNM stage would be T4b, Any N, M0), OR the cancer is of any size and has spread to seven or more lymph nodes, but not to other organs (its TNM stage would be Any T, N3, M0).

Stage 4

The cancer has spread to lymph nodes and other parts of the body, such as the liver, lungs or stomach (its TNM stage would be Any T, Any N, M1). This is known as secondary or metastatic cancer.